Richard L Morrow1, Ken Bassett2, James M Wright2, Greg Carney2, Colin R Dormuth2. 1. Departments of Anesthesiology, Pharmacology and Therapeutics (Morrow, Bassett, Wright, Carney, Dormuth), Family Practice (Bassett), and Medicine (Wright), University of British Columbia, Vancouver, BC richard.morrow@ubc.ca. 2. Departments of Anesthesiology, Pharmacology and Therapeutics (Morrow, Bassett, Wright, Carney, Dormuth), Family Practice (Bassett), and Medicine (Wright), University of British Columbia, Vancouver, BC.
Abstract
BACKGROUND: The College of Physicians and Surgeons of British Columbia introduced opioid prescribing standards and guidelines in mid-2016 in British Columbia. We evaluated impacts of the standards and guidelines on health outcomes. METHODS: We conducted a longitudinal study with repeated measures using administrative data from December 2013 to March 2017. The study included BC patients with long-term use of prescription opioids. Those with a history of long-term care, palliative care or cancer were excluded. Patients were followed for a 12-month prepolicy period and 10-month postpolicy period and compared with historical controls. We estimated changes in level (sudden changes) and monthly trend (gradual changes) of rates of opioid overdose hospital admission, and secondary outcomes of all-cause hospital admission, all-cause emergency department visits, opioid overdose mortality and all-cause mortality. RESULTS: The study included 68 113 patients in the main cohort and 68 429 historical controls. We did not find significant changes to opioid overdose hospital admissions in level (adjusted rate ratio [RR] 0.83, 95% confidence interval [CI] 0.45-1.54) or in trend (adjusted RR 1.00, 95% CI 0.91-1.10). All-cause hospital admissions declined in level but may have increased in trend, suggesting that a temporary decrease in hospital admissions may have occurred. We found no significant changes in all-cause emergency department visits, opioid overdose mortality or all-cause mortality. INTERPRETATION: Among patients with a history of long-term prescription opioid use, the regulatory prescribing standards and guidelines were not associated with changes in opioid overdose hospital admissions, all-cause emergency department visits, opioid overdose mortality or all-cause mortality, or with a sustained reduction in all-cause hospital admissions, over a 10-month period after they were introduced. Future research should investigate whether opioid prescribing standards or guidelines are associated with use of nonopioid analgesic medications or nonpharmacologic treatments. Copyright 2020, Joule Inc. or its licensors.
BACKGROUND: The College of Physicians and Surgeons of British Columbia introduced opioid prescribing standards and guidelines in mid-2016 in British Columbia. We evaluated impacts of the standards and guidelines on health outcomes. METHODS: We conducted a longitudinal study with repeated measures using administrative data from December 2013 to March 2017. The study included BC patients with long-term use of prescription opioids. Those with a history of long-term care, palliative care or cancer were excluded. Patients were followed for a 12-month prepolicy period and 10-month postpolicy period and compared with historical controls. We estimated changes in level (sudden changes) and monthly trend (gradual changes) of rates of opioid overdose hospital admission, and secondary outcomes of all-cause hospital admission, all-cause emergency department visits, opioid overdosemortality and all-cause mortality. RESULTS: The study included 68 113 patients in the main cohort and 68 429 historical controls. We did not find significant changes to opioid overdose hospital admissions in level (adjusted rate ratio [RR] 0.83, 95% confidence interval [CI] 0.45-1.54) or in trend (adjusted RR 1.00, 95% CI 0.91-1.10). All-cause hospital admissions declined in level but may have increased in trend, suggesting that a temporary decrease in hospital admissions may have occurred. We found no significant changes in all-cause emergency department visits, opioid overdosemortality or all-cause mortality. INTERPRETATION: Among patients with a history of long-term prescription opioid use, the regulatory prescribing standards and guidelines were not associated with changes in opioid overdose hospital admissions, all-cause emergency department visits, opioid overdosemortality or all-cause mortality, or with a sustained reduction in all-cause hospital admissions, over a 10-month period after they were introduced. Future research should investigate whether opioid prescribing standards or guidelines are associated with use of nonopioid analgesic medications or nonpharmacologic treatments. Copyright 2020, Joule Inc. or its licensors.
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